Applications for Insurance

For your convenience, we have provided the following applications and questionnaires in .pdf, .doc, and .xls format.

1. Follow the link to the appropriate application.
2. Fill out the PDF fillable form, word doc, or excel file on your computer.
3. Save the file.
4. Send an email to your Clarke & Sampson agent with the attached file.
Helpful Hint: Download the applications by "right clicking" and download the linked file to avoid internet browser errors.
Some fIles may not appear to be electronically fillable. Simply click on the space you would like to fill and a text bar will appear.


General Surety Form-  Travelers

Commercial Surety Application

Commercial Surety Application- The Hartford

Probate/Court Bond Application- Travelers


Fiduciary Liability New Business & Renewal App- Travelers

WRAP App- Travelers

Exporters Package Application- Chubb

Defense Base Act Application

Cyber Security App

Multimedia Liability App- Chubb

Private Company Forefront App- Chubb

Liquor Liability Application- US Liability

Disability Benefits Law Application- The Hartford

Special Programs

Political Campaign Insurance Application

Restaurant Insurance Questionnaire

Non-Profit Forefront Application- Chubb

Special Events

Amateur Sport Event Insurance Application

Non Sporting Event Insurance Application

Liquor Liability Special Event Application

Life & Health

Employee Census


WC Waiver of Subrogation Request ERM-14 Form

Commercial- ESIGN Delivery Consent

Personal- ESIGN Delivery Consent